Adherence decision making in the everyday lives of emerging adults with type 1 diabetes

Abstract

PurposeThe purpose of this study was to explore motivations underlying nonadherent treatment decisions made by young adults with type 1 diabetes.MethodsEight emerging adults each completed a series of semi-structured interviews concerning their approaches to diabetes care, relationships with clinicians, and everyday activities and routines. A narrative thematic analysis was used to develop initial themes and refine them through continued data collection and review of the research literature.ResultsFive themes were identified as motivating nonadherence: (1) efforts to mislead health care providers, (2) adherence to alternative standards, (3) treatment fatigue and burnout, (4) social support problems, and (5) emotional and self-efficacy problems.ConclusionInstances of nonadherence generally involved a combination of the five identified themes. Participants reporting nonadherence also described difficulties communicating with care providers regarding their treatment. Nonjudgmental communication between providers and emerging adults may be particularly important in promoting positive health outcomes in this population.

Narrative inquiry in diabetes research: Illuminating the psychosocial aspects of diabetes

“…. but more and more they have better standards" [30]. Fluctuating treatment standards appeared to overwhelm young adults in this study.…”

“…Narrative inquiry can also provide insight into the role of friends [30,31]. A narrative study investigating emerging adults' (age 19-25) perspectives on nonadherence to diabetes self-care discovered social support problems [30].…”

“…A narrative study investigating emerging adults' (age 19-25) perspectives on nonadherence to diabetes self-care discovered social support problems [30]. They were adversely influenced by friends.…”

“…Two narrative studies explored disengagement in diabetes self-care and treatment [23,30]. Participants from these studies reported uncertainty, psychosocial adjustment, and weariness.…”

“…For example, "The doctor told me that I have to do some physical activity, but he didn't advise on the kind of exercises I should do" [23]. Shifting blood glucose targets were a source of uncertainty among young adults (ages 19-25) with type 1 diabetes enrolled in higher education [30]. The standards for blood glucose control shift as children transition from youth to adulthood and encounter more intensive therapies.…”